Did you have your water broken while you were in labor? Artificial rupture of membranes (ARM), which is also more commonly referred to as the breaking of the waters, is a common intervention during labor. To break the amniotic sac, the doctor or midwife uses an amni-hook, which looks sort of like a big crochet needle, to artificially tear the membranes. ARM is usually the second step performed during an induction and may also be used in an attempt to speed up a spontaneous labor.

In my opinion, artificially rupturing the amniotic sac sounds awful. Before I gave birth to my daughter, I knew that I did not want to have my water broken. Thankfully, my midwife did not routinely use the intervention. Because my water broke at the beginning of my labor, I ultimately did not have to decide whether or not to have my membranes broken; however, looking back, I know that I still would not have chosen ARM during my labor and birth.

The main reason that I would never consent to ARM is that the amniotic sac plays an important role during both pregnancy and labor. During pregnancy, the amniotic sac protects the developing baby including cushioning the fetus from the outside world. As the baby breathes the amniotic fluid and and out, his or her lungs develop. The amniotic fluid inside the amniotic sac changes flavor depending on the diet of the mother; I personally made sure to eat a lot of healthy foods including vegetables like broccoli and Brussels sprouts so that my baby would learn and start to enjoy the tastes prenatally. Finally, the amniotic sac and fluid protect the baby against microbes. Breaking the sac artificially can unnecessarily introduce infection-causing germs to the mother and the baby.

During labor, the amniotic sac and amniotic fluid continue to protect the baby from the outside world. During each contraction, the fluid-filled sac cushions the baby against the change in pressure. Breaking the bag of waters artificially can cause unnecessary stress on the unborn baby by putting all of the pressure of each contraction directly on the baby and the umbilical cord. When the umbilical cords becomes compressed, reduced blood flow can cause dangerous changes in the baby’s heartbeat. I wanted my baby to continue to receive all the benefits of his or her amniotic sac during labor, which is the main reason that I would not have consented to ARM.

Furthermore, artificially breaking the waters can make contractions more intense and more painful. Contractions are already intense and painful, so I do not understand why a laboring woman would consent to an unnecessary intervention that makes her labor even more intense and painful. When the amniotic sac is artificially ruptured, the umbilical cord too can become prolapsed, meaning the cord passes or gets trapped by the baby’s head. A prolapsed cord can cause further stress on the baby. Cord prolapse can also cut off the blood supply to the baby, which can necessitate an immediate emergency cesarean section and may cause death to the baby.

Finally, when the amniotic sac breaks, the fluid that flows out of the vagina helps to cleanse the birth canal by pushing germs down and out. Breaking the sac artificially or too early not only can introduce germs into the womb but can also reduce the effectiveness of the amniotic fluid at cleansing the birth canal. The amniotic fluid also helps to lubricate the vagina as the baby emerges.

When my daughter was born, my water broke at the beginning of my labor. However, she had already dropped into place in my pelvis. I was leaking fluid, but, because her head was already engaged, the rest of her body remained largely still surrounded by amniotic fluid. My midwife check my daughter’s heartbeat every so often throughout my labor. Not once did her little heartbeat become too low or too high, most likely because her little body continued to be cushioned by her amniotic sac and fluid.

Furthermore, for the amniotic sac to break during labor and birth is not actually necessary. Some babies are born still inside the sac, which is referred to as being born in the caul. Historically, being born in the caul was considered lucky. It would have been totally cool had my daughter been born still inside her amniotic sac. Instead, she thought that it was cooler to break her sac on her own and pop out after only four and a half hours, which I also think was pretty cool.

Before consenting to ARM, women need to be made aware that the intervention is not without risks including the risk of infection, the risk of additional and potentially life-threatening stress on the baby, and the risk of more painful contractions. The amniotic sac is so important; why artificially break the waters when doing so is unnecessary?

Did you have your membranes artificially ruptured? Were you aware of the risks? Did you realize how important the amniotic sac is?

References

In defence of the amniotic sac: http://midwifethinking.com/2010/08/20/in-defence-of-the-amniotic-sac/

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Author: Heather Johnson
Heather Johnson is a mother, wife, writer, librarian, and linguist. She earned a BA in English studies with a minor in creative writing from Illinois State University in May 2007, an MS in library and information science from the University of Illinois at Urbana-Champaign in May 2009, and an MS in English studies with an emphasis in linguistics at Illinois State University in December 2011.

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